Referral Forms and Services
Services
- We provide CPAP and Respiratory home medical equipment and supplies
- Serving Hawai’i for over 30 years
- Local, professional staff available by phone
- We carry a full line of CPAP products, with the latest model machines and masks from the top brands in the industry
- We accept all insurance EXCEPT: fee-for-service Medicare (MEDICARE PART B), Kaiser, and VA (Advantage plans are ok)
- We carry:
- CPAP and BIPAP
- Non-Invasive Ventilation
- Home Oxygen
For new referrals, Please use the forms below and fax to (808) 261-8896.
If you have any questions, please call during business hours and we can assist
Referral Forms
Standard CPAP/BILEVEL Order Form and Checklist
BiPAP ST or ASV order form (Bilevel with RATE)
To expedite the process for your Re-Supply Transfer patients, Please advise the patient to download this form and be ready to provide to P.I.M.